In the Interest of the Child

by Richard Doerflinger

July 27, 2007

One success story in government efforts for better health care is SCHIP (the State Children's Health Insurance Program). Since 1997 this federal program has helped states provide coverage for millions of children who fall between the cracks of the health care system – children, for example, whose families are not "low-income" enough for Medicaid but can't afford decent private health insurance. SCHIP's pending reauthorization by Congress offers an opportunity to reflect on what we want most for children in our society.

Federal support for abortion in the program is prohibited except for the rare "hard cases" of danger to the mother's life or rape/incest, reflecting the policy that governs federal Medicaid funds. States may implement SCHIP by extending coverage under Medicaid, by setting up a distinct state children's health program, or by a combination of both. The distinct state program has the advantage of allowing a state to tailor its services to children's special health needs, while excluding controversial and morally problematic procedures like abortion and sterilization for minors (as Michigan and Pennsylvania have done).

In 2002 the Bush administration improved the program further, by clarifying the word "child" in the legislation to include the unborn child. This allows states to use state and federal funds for prenatal care and other basic needs of these children and their mothers. Providing coverage in the name of the unborn child, of course, recognizes simple reality – every obstetrician knows that when he provides care to a pregnant woman, he has two patients. But it also has two practical benefits. First, it does not have the effect of expanding abortions, since no sane person can claim to be aborting a child to promote his or her health. Second, care can be provided to needy mothers and children whatever the immigrant status of the mother. The unborn child is not deemed to be an immigrant (legal or otherwise), and when born will be a U.S. citizen – a much healthier citizen, if the mother receives good prenatal care.

This is a beautifully elegant way to provide life-affirming care to both women and children, and is already being implemented in 11 states. Therefore, of course, pro-abortion groups hate it. In recent years they have tried but failed to supplant the "unborn child" rule with legislation authorizing coverage in the name of the "pregnant woman" alone – because they oppose any recognition of unborn children as children, and because they want to make it easy for pregnant women to get elective abortions in the 17 states that use their own funds for such abortions in Medicaid. In short, the adult pregnant woman is treated as a child to make it easier to kill the real child, in a program to promote "children's health."

Now a new Congress with less pro-life support is about to reauthorize this ten-year-old program, and these ideologues will try to get their way. But pro-life members of Congress will work to codify the "unborn child" rule, to keep this program focused on life-affirming care for vulnerable children and their mothers in need. Congress should reauthorize SCHIP -- and should try to get it right, in the interest of the child.

Mr. Doerflinger is Deputy Director of the Secretariat for Pro-Life Activities, U.S. Conference of Catholic Bishops.

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